Etiologies of diarrhea
Gastroenteritis (from viral or bacterial pathogens), contaminated water Food intolerance Celiac disease IBS, IBD Medications (ABX and chemotherapy)
What do you have to watch out for if a patient has diarrhea while taking ABX?
Make sure it’s not a C. diff infection!
Opiate derivative medications for diarrhea
Diphenoxylate with atropine
What does the atropine do in the combo with diphenoxylate?
Reduce abuse potential
Loperamide (Imodium) dosing
4mg, then 2mg up to 16mg/day
Who should you not use opiate derivative medications in?
Patients with a bacterial infection
Side effect of opiate derivatives
Uses for octreotide
Intestinal carcinoid tumors and chemo-induced diarrhea
Octreotide route of administration and dosing frequency
SQ as a depo shot q4w
Non-pharm options for diarrhea
Pedialyte for little kids
Avoid lactose until resolution
(BRAT diet is NOT recommended)
Bismuth subsalicylate (Pepto Bismol) age minimum
> 12 years
There’s a children’s version available but it doesn’t treat the diarrhea
Pepto Bismol dosing
524mg q30-60mins PRN up to 8 doses/24 hours
Probiotics for diarrhea
May help with C. diff diarrhea, but not recognized by the FDA as medications
Digestive enzymes for diarrhea
Lactaid for lactose intolerance